Joint Injections for Osteoarthritic Knee Pain

NCT ID: NCT00085722

Last Updated: 2019-02-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

98 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-07-31

Study Completion Date

2016-05-01

Brief Summary

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The purpose of this study is to determine whether prolotherapy (PrT), a therapy based on injection of a sugar solution in and around the knee, can decrease pain and disability from knee osteoarthritis (OA).

Detailed Description

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OA is a common, debilitating condition for which there is no cure and no known cause. Prolotherapy (PrT) is an injection-based therapy for chronic musculoskeletal pain in which an irritant solution is injected at painful ligaments and tendons to produce stronger connective tissue and decrease pain. Although limited studies suggest PrT is effective may be effective for low back pain, its use has not been rigorously studied in human clinical trials for osteoarthritis.

Participants in this study will be randomly assigned to receive one of three treatments: standard PrT, injections with a saline placebo, or a pamphlet with recommendations for home knee physical therapy. Injections will be given at Weeks 1, 5, and 9; injection group subjects will have the option to receive an additional 2 sets of injections. All participants will be assessed for a total of 1 year. A set of disease-specific and general quality-of-life questionnaires will be used to assess participants' outcomes . A randomized subset of participants (N=38)will receive magnetic resonance imaging (MRI)of the knee at baseline and 52 weeks. At study completion, participants who did not receive PrT will have the option to receive up to five sessions of PrT at no cost. Data will be collected for this group (minus MRI) and will be analyzed separately. Enrollment is limited to residents of Southern Wisconsin.

Conditions

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Osteoarthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Dextrose

Subjects in Group 1 receive PrT with 15% and 25% dextrose solution, as it is generally practiced in the US today.

Group Type EXPERIMENTAL

Dextrose Prolotherapy

Intervention Type PROCEDURE

Injection procedure: 50% dextrose is diluted with .9% 'normal' saline and 1% lidocaine to achieve 15% dextrose for ligament injections and 25% dextrose for intra-articular injection.

Normal saline

Subjects in Group 2 will receive the same treatment as Group 1, except that a 0.9% 'normal' saline solution with no known benefit will be used instead of dextrose.

Group Type PLACEBO_COMPARATOR

Saline Prolotherapy

Intervention Type PROCEDURE

7 mL 9% 'normal' saline and 3mL 1% lidocaine

Exercise

At-home physical therapy exercises as a non-injection control

Group Type OTHER

At-home physical therapy exercise group

Intervention Type OTHER

Subjects in the at-home physical therapy exercise group will receive a patient information pamphlet about knee osteoarthritis and conservative care instructions for standard at-home physical therapy exercises

Interventions

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Dextrose Prolotherapy

Injection procedure: 50% dextrose is diluted with .9% 'normal' saline and 1% lidocaine to achieve 15% dextrose for ligament injections and 25% dextrose for intra-articular injection.

Intervention Type PROCEDURE

Saline Prolotherapy

7 mL 9% 'normal' saline and 3mL 1% lidocaine

Intervention Type PROCEDURE

At-home physical therapy exercise group

Subjects in the at-home physical therapy exercise group will receive a patient information pamphlet about knee osteoarthritis and conservative care instructions for standard at-home physical therapy exercises

Intervention Type OTHER

Other Intervention Names

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Dextrose Saline Exercise

Eligibility Criteria

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Inclusion Criteria

* Pain from knee osteoarthritis that has impacted life for 3 months to 10 years
* X-ray results indicating knee osteoarthritis

Exclusion Criteria

* Knee osteoarthritis surgical candidate
* History of total knee joint repair
* Prior use of PrT
* Prior fracture of the knee joint
* Joint injection of steroids or other drugs within the past 3 months
* Rheumatoid or inflammatory arthritis
* Chronic use of narcotic medication
* Other chronic pain diagnoses
* diabetes mellitus
* Body mass index (BMI) greater than 45
* Unresolved litigation
* Pregnancy
* Co-morbidity that may interfere with the study
Minimum Eligible Age

40 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Center for Complementary and Integrative Health (NCCIH)

NIH

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David P. Rabago, MD

Role: PRINCIPAL_INVESTIGATOR

University of Wisconsin Dept of Family Medicine

Locations

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Northeast Family Medical Center

Madison, Wisconsin, United States

Site Status

University of Wisconsin General Clinical Research Center

Madison, Wisconsin, United States

Site Status

Countries

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United States

References

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Rejeski WJ, Ettinger WH Jr, Shumaker S, Heuser MD, James P, Monu J, Burns R. The evaluation of pain in patients with knee osteoarthritis: the knee pain scale. J Rheumatol. 1995 Jun;22(6):1124-9.

Reference Type BACKGROUND
PMID: 7674241 (View on PubMed)

Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000 Aug;6(4):311-20. doi: 10.1089/10755530050120673.

Reference Type BACKGROUND
PMID: 10976977 (View on PubMed)

Eberle E, Ottillinger B. Clinically relevant change and clinically relevant difference in knee osteoarthritis. Osteoarthritis Cartilage. 1999 Sep;7(5):502-3. doi: 10.1053/joca.1999.0246. No abstract available.

Reference Type BACKGROUND
PMID: 10489324 (View on PubMed)

Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993 Feb;6(1):23-33.

Reference Type BACKGROUND
PMID: 8439713 (View on PubMed)

Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet. 1987 Jul 18;2(8551):143-6. doi: 10.1016/s0140-6736(87)92340-3.

Reference Type BACKGROUND
PMID: 2439856 (View on PubMed)

Dechow E, Davies RK, Carr AJ, Thompson PW. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999 Dec;38(12):1255-9. doi: 10.1093/rheumatology/38.12.1255.

Reference Type BACKGROUND
PMID: 10587555 (View on PubMed)

Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976). 2004 Jan 1;29(1):9-16; discussion 16. doi: 10.1097/01.BRS.0000105529.07222.5B.

Reference Type BACKGROUND
PMID: 14699269 (View on PubMed)

Hackett GS, Hemwall GA, Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. Fifth Ed. ed. Oak Park: Gustav A. Hemwall, 1993

Reference Type BACKGROUND

Linetsky FS, FRafael M,. Pain Management, 2002:381-402.

Reference Type BACKGROUND

Dorman TA. Prolotherapy: A survey. The Journal of Orthopaedic Medicine 1993;15(2):49-50

Reference Type BACKGROUND

Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80.

Reference Type BACKGROUND
PMID: 10710805 (View on PubMed)

Rogers WH, Wittink H, Wagner A, Cynn D, Carr DB. Assessing individual outcomes during outpatient multidisciplinary chronic pain treatment by means of an augmented SF-36. Pain Med. 2000 Mar;1(1):44-54. doi: 10.1046/j.1526-4637.2000.99102.x.

Reference Type BACKGROUND
PMID: 15101963 (View on PubMed)

Rabago D, Patterson JJ, Mundt M, Zgierska A, Fortney L, Grettie J, Kijowski R. Dextrose and morrhuate sodium injections (prolotherapy) for knee osteoarthritis: a prospective open-label trial. J Altern Complement Med. 2014 May;20(5):383-91. doi: 10.1089/acm.2013.0225. Epub 2014 Mar 17.

Reference Type DERIVED
PMID: 24635447 (View on PubMed)

Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013 May-Jun;11(3):229-37. doi: 10.1370/afm.1504.

Reference Type DERIVED
PMID: 23690322 (View on PubMed)

Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, Grettie J, Patterson JJ. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012 Apr;18(4):408-14. doi: 10.1089/acm.2011.0030.

Reference Type DERIVED
PMID: 22515800 (View on PubMed)

Related Links

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http://www.fammed.wisc.edu/

University of Wisconsin Department of Family Medicine Web Site

Other Identifiers

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K23AT001879-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H-2004-0112

Identifier Type: -

Identifier Source: org_study_id

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